The DOI matches its Crossref record; 58 of the 58 references it cites were found in a registry or an index.
Impact of intensity of practice after stroke: Issues for consideration
Abstract
PURPOSE: The present debate paper addresses four relevant issues related to the impact of intensity of practice after stroke. First, the best way to define intensity of practice is discussed. Second, the paper describes the evidence that exists for a dose-response relationship in stroke rehabilitation. Third, the relevance of an appropriate patient selection for a meaningful intensive practice is explored. Finally, the paper raises the question of what it is that patients actually learn when they improve their functional skills. Search strategy. For this purpose articles from MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, DARE and PiCarta and references presented in relevant publications were examined. DISCUSSION AND CONCLUSION: Although, there is strong evidence that early augmented exercise therapy time (expressed as time dedicated to practice) may enhance functional recovery, there is a discrepancy between the evidence for the benefits of intensive practice, on the one hand, and, the implementation of intensive rehabilitation treatment programmes in the current healthcare system on the other. Further emphasis should be given on a better understanding of the time-dependency of prognostic factors that determine the effectiveness of intensive practice in patients with stroke. In addition, a better understanding is needed of the neurophysiological and biomechanical mechanisms that underlie compensation-related learning of functional tasks after stroke.
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“Definitions for therapy intensity vary, but to date the focus has been on amount (minutes) rather than frequency (repetitions of a task, or sessions per day).16”
From Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT) (2016) · cites this paper as [16]
Citations
Cites
Ericsson, K. A. (2004) · Academic Medicine · doi:10.1097/00001888-200410001-00022 · Cited by 2,988
Technique to improve chronic motor deficit after stroke.
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Probability of Regaining Dexterity in the Flaccid Upper Limb
Kwakkel, G., Kollen, B. J., van der Grond, J., & Prevo, A. J. H. (2003) · Stroke · doi:10.1161/01.str.0000087172.16305.cd · Cited by 1,409
Self-citationEffects of Augmented Exercise Therapy Time After Stroke: A Meta-Analysis
Kwakkel, G., van Peppen, R., Wagenaar, R. C., Wood Dauphinee, S., Richards, C., Ashburn, A., Miller, K., Lincoln, N., Partridge, C., Wellwood, I., et al. (2004) · Stroke · doi:10.1161/01.str.0000143153.76460.7d · Cited by 1,081
Self-citationCompensatory strategies for reaching in stroke
Cirstea, C. M., & Levin, M. F. (2000) · Brain · doi:10.1093/brain/123.5.940 · Cited by 1,009
THE RESTORATION OF MOTOR FUNCTION FOLLOWING HEMIPLEGIA IN MAN
Twitchell, T. E. (1951) · Brain · doi:10.1093/brain/74.4.443 · Cited by 942
The impact of physical therapy on functional outcomes after stroke: what's the evidence?
Van Peppen, R. P., Kwakkel, G., Wood-Dauphinee, S., Hendriks, H. J., Van der Wees, P. J., & Dekker, J. (2004) · Clinical Rehabilitation · doi:10.1191/0269215504cr843oa · Cited by 942
Self-citationIntensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial
Kwakkel, G., WAGENAAR, R. C., Twisk, J. W. R., Lankhorst, G. J., & Koetsier, J. C. (1999) · The Lancet · doi:10.1016/s0140-6736(98)09477-x · Cited by 931
Self-citationPhysical fitness training for stroke patients
Saunders, D. H., Sanderson, M., Hayes, S., Kilrane, M., Greig, C. A., Brazzelli, M., & Mead, G. E. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003316.pub6 · Cited by 759
Understanding the pattern of functional recovery after stroke: Facts and theories
Kwakkel, G., Kollen, B., & Lindeman, E. (2004) · Restorative Neurology and Neuroscience · doi:10.3233/rnn-2004-00282 · Cited by 727
Self-citation
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- Saunders D H, 2004, Cochrane Database Syst Rev
- Kwakkel G, 2002, J Neurol Neurosurg Psychiat, 72, 473
- Kwakkel G, 2004, Restor Neurol Neurosci (Review), 22, 281
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Cited by
Sorted by citations
Effects of Robot-Assisted Therapy on Upper Limb Recovery After Stroke: A Systematic Review
Kwakkel, G., Kollen, B. J., & Krebs, H. I. (2007) · Neurorehabilitation and neural repair · doi:10.1177/1545968307305457 · Cited by 1,503
Self-citationWhat Do Motor “Recovery” and “Compensation” Mean in Patients Following Stroke?
Levin, M. F., Kleim, J. A., & Wolf, S. L. (2008) · Neurorehabilitation and neural repair · doi:10.1177/1545968308328727 · Cited by 961
Repairing the human brain after stroke: I. Mechanisms of spontaneous recovery
Cramer, S. C. (2008) · Annals of Neurology · doi:10.1002/ana.21393 · Cited by 875
Interventions for improving upper limb function after stroke
Pollock, A., Farmer, S. E., Brady, M. C., Langhorne, P., Mead, G. E., Mehrholz, J., & van Wijck, F. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010820.pub2 · Cited by 909
Observation of Amounts of Movement Practice Provided During Stroke Rehabilitation
Lang, C. E., MacDonald, J. R., Reisman, D. S., Boyd, L. A., Kimberley, T. J., Schindler-Ivens, S., Hornby, T. G., Ross, S. A., & Scheets, P. L. (2009) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2009.04.005 · Cited by 707
Metadata
- Authors
- Kwakkel, G.
- Affiliations
- University Medical Center Utrecht (NL)
- Corresponding author
- Kwakkel, Gert
- ORCID
- Kwakkel, Gert
- Venue
- Disability and Rehabilitation
- Publisher
- Informa UK Limited
- Published
- 2006-01
- Volume
- 28
- Issue
- 13-14
- Pages
- 823-830
- ISSN
- 0963-8288 (ISSN-L)
- 1464-5165
- OpenAlex
- W2135838445
- Cited by
- 417
- References
- 58
- Citations by year
- 2026: 10 · 2025: 5 · 2024: 11 · 2023: 28 · 2022: 29 · 2021: 21 · 2020: 17 · 2019: 23 · 2018: 24 · 2017: 14 · 2016: 24 · 2015: 30 · 2014: 37 · 2013: 19 · 2012: 21
- FWCI
- 3.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Disability and Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- ZonMw
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
- Keywords
- stroke rehabilitation, intensive rehabilitation, dose-response relationship, patient selection, functional recovery, neurophysiological mechanisms, biomechanical mechanisms
- MeSH terms
- Stroke Rehabilitation, Activities of Daily Living, Exercise Therapy, Humans, Motor Activity, Prognosis, Rehabilitation, Randomized Controlled Trials as Topic, Treatment Outcome, Recovery of Function, Physical Therapy Modalities
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